RN, Case Manager, Per Diem

UMass Memorial Health; Southbridge (MA); On-site; USD 58,000 - 104,000; Full time

Benefits offered by this job

Signing bonus potential

Job summary

UMass Memorial Health is seeking a skilled Case Manager to coordinate discharge planning and utilization review, ensuring seamless continuity of care in both ambulatory and emergency settings.

The role requires knowledge of InterQual criteria, strong communication with health plans, and accurate clinical documentation in Medhost and Meditech. Join a mission-driven health system with a commitment to patient care and teamwork.

Qualifications

• Current Massachusetts Nursing License.
• Graduate of an accredited school of nursing (RN or BSN).
• Experience in discharge planning and utilization review.

Responsibilities

• Demonstrates a comprehensive knowledge of case management theory and practices.
• Demonstrates ability to plan for patients' continuity of care in ambulatory and emergency settings.
• Clinical documentation in Medhost and Meditech.
• Demonstrates understanding of Care Management principles and InterQual Criteria.
• Communicates effectively with health plan case managers regarding bed status and insurance authorization.

Skills

Discharge planning

Utilization review

InterQual Criteria

Communication with health plans

Nursing theory knowledge

Education

RN or BSN degree

Tools

Medhost

Meditech

Job description

Exemption Status: Non-Exempt

Hiring Range: $41.81 - $75.25 experience, skills, qualifications, and internal equity considerations

Schedule Details: Monday through Friday, Weekends (Saturday and Sunday)

Scheduled Hours: 8a-430p

Shift: 1 - Day Shift, 8 Hours (United States of America)

Hours: 0

Cost Center: 25080 - 4402 Case Management

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

I. Major Responsibilities:

• Demonstrates a comprehensive knowledge of case management theory and practices.
• Demonstrates ability to effectively plan for patients' continuity of care needs in ambulatory care and emergency care settings.
• Clinical documentation in Medhost and Meditech
• Demonstrates understanding of the principles of Care Management
• Demonstrates accurate understanding of InterQual Criteria
• Demonstrates effective communication in a timely fashion with all involved departments concerning the appropriateness of bed status and insurance authorization
• Demonstrates effective communication with health plan case managers regarding the policies for the ECC patient.
• Demonstrates knowledge of general nursing theory and practices
• Demonstrates knowledge of discharge planning rules and regulations
• Informs director of any and all discharge planning incidents which are barriers to effective.

Standard Staffing Level Responsibilities:

• Complies with established departmental policies, procedures and objectives.
• Attends variety of meetings, conferences, seminars as required or directed.
• Demonstrates use of Quality Improvement in daily operations.
• Complies with all health and safety regulations and requirements.
• Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
• Maintains, regular, reliable, and predictable attendance.
• Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.

II. Position Qualifications:

License/Certification/Education:

Required:

• Current Massachusetts Nursing License
• Graduate of an accredited school of nursing, RN or BSN

Experience/Skills:

Required:

• Experience in discharge planning and utilization review

Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.

III. Physical Demands and Environmental Conditions:

• Moderate physical activity required including but not limited to walking. Must demonstrate emotional stability. May be required to work additional hours. Must demonstrate flexibility in relating to individuals of varying disabilities, and from different cultures, socio-economic and spiritual backgrounds
• This job requires that weight be lifted, or force be exerted.
• Good Physical Environment. May have to travel outside the hospital to attend workshops and conferences

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at [e-mail]. We will make every effort to respond to your request for disability assistance as soon as possible.